Predicting performance: relative importance of students' background and past performance

ContextDespite evidence for the predictive value of both pre-admission characteristics and past performance at medical school, their relative contribution to predicting medical school performance has not been thoroughly investigated. ObjectivesThis study was designed to determine the relative importance of pre-admission characteristics and past performance in medical school in predicting student performance in pre-clinical and clinical training. MethodsThis longitudinal prospective study followed six cohorts of students admitted to a Dutch, 6-year, undergraduate medical course during 2002-2007 (n=2357). Four prediction models were developed using multivariate logistic regression analysis. Main outcome measures were Year1 course completion within 1year' (models 1a, 1b), Pre-clinical course completion within 4years' (model 2) and Achievement of at least three of five clerkship grades of 8.0' (model 3). Pre-admission characteristics (models 1a, 1b, 2, 3) and past performance at medical school (models 1b, 2, 3) were included as predictor variables. ResultsIn model 1a - including pre-admission characteristics only - the strongest predictor for Year1 course completion was pre-university grade point average (GPA). Success factors were selected by admission testing' and age>21years'; risk factors were Surinamese/Antillean background', foreign pre-university degree', doctor parent' and male gender. In model 1b, number of attempts and GPA at 4months were the strongest predictors for Year1 course completion, and male gender remained a risk factor. Year1 GPA was the strongest predictor for pre-clinical course completion, whereas being male or aged 19-21years were risk factors. Pre-clinical course GPA positively predicted clinical performance, whereas being non-Dutch or a first-generation university student were important risk factors for lower clinical grades. Nagelkerke's R-2 ranged from 0.16 to 0.62. ConclusionsThis study not only confirms the importance of past performance as a predictor of future performance in pre-clinical training, but also reveals the importance of a student's background as a predictor in clinical training. These findings have important practical implications for selection and support during medical school